Josh Wilkerson and his fiancé, Rose Walters, needed to save money.
They were planning a wedding, and Wilkerson, a Type 1 diabetic, had aged out of his stepfather’s health insurance. The 27-year-old now had to pay nearly $1,200 a month for insulin he needed to stay alive.
Wilkerson makes just $16.50 per hour working at a dog kennel, and like many young diabetics, it was a price tag he couldn’t afford.
He asked his doctor about other insulin options, and was told about a lower-grade insulin that was more affordable and available at Walmart, ReliOn.
Wilkerson and Walters, who also has Type 1 diabetes, decided to try the over-the-counter insulin together, she told The Washington Post
“We figured: Hey, it’s $25. We can do that. And we’ll just work with it and try to do the best we can,” Walters, 27, said.
While this lower-grade insulin is more affordable, The Washington Post reports that it can take up to four hours to metabolize and regulate blood sugar levels, without definitive success rates.
“The fact that it takes so long to kick in? It scared me a little bit,” she said.
The extra time needed means that users have to have a strict schedule, making sure to take the correct dosage and that they take it far enough in advance of eating for it to work.
In 2015, a woman using the Walmart insulin told NPR that she suffered if she didn’t get the size of the dose and timing just right.
“It’s a quick high and then, it’s a down,” Carmen Smith told the outlet at the time. “The down part is, you feel icky. You feel lifeless. You feel pain. And the cramps are so intense — till you can’t walk, you can’t sit, you can’t stand.”
Once Wilkerson started taking the over the counter insulin, he began experiencing intense stomach problems and mood swings from high blood sugar levels.
“Something in him, you could just tell, was different,” Walters, who had a better experience with the cheaper insulin, told The Washington Post. “I would tell him, ‘Check your blood sugar,’ and he would check it, and it would be high.”
In June, just four months before their wedding, Wilkerson was asked to stay overnight at the Northern Virginia dog kennel while his manager was on vacation. He agreed, because it was a way to make extra money.
When Walters didn’t hear from her fiancé for some time, she rushed to the kennel where she found him unconscious.
“I just remember smacking him on the face, saying, ‘Babe, wake up. You have to wake up,’ ” Walters said.
Doctors later determined that he had suffered several strokes just a few hours after taking a dose of the lower-grade insulin. He had fallen into a diabetic coma due to his blood sugar levels being 17 times higher than normal.
Five days later, he was taken off life support.
“It’s very hard,” Walters said. “How many more young Type 1 diabetes patients have to die before something finally changes?”
In a statement to PEOPLE, Walmart said “All patients should work with their medical provider to help manage their diabetes, including which is the best form of insulin for their treatment. The high cost of insulin is a concern for those trying to manage their diabetes, and human insulin can be a less expensive alternative, but it may not be right for everyone, which is why it is very important patients work with their doctor on the best way to treat their diabetes.”
RELATED VIDEO: EpiPen Maker Under Fire After Hiking Price of Live-Saving Injector to $500
The prescription brands of insulin only need 20 minutes to metabolize. However, the prices of these versions have almost tripled since 2002, The Washington Post reported, and more and more diabetes patients are unable to afford the medication.
In an in-depth look at the rising prices, some families told PEOPLE in June that they have given up vacations, taken out second mortgages and even filed for bankruptcy. Some are buying insulin on the black market or going out of the country to places like Canada, where it’s a fraction of the cost.
“It’s pretty much a death sentence,” Wilkerson’s mother, Erin Weaver said of diabetics who are forced to ration insulin or use the less reliable over the counter version. “They have no health insurance or good jobs to afford what they need, so they’re left with the pittance that is left.”