Opioids in exchange for (critical) care

How would you handle this? 20yo F w/ DM1 admitted about twice per month in DKA (perhaps more to other hospitals), never takes her insulin, gives no sh*ts about her health, not even sure she fully understands the risks of her behavior. Her BGs are always ridiculous. The most recent time I admitted her: wide open gap, serum BG was >1,800 (above the upper limit of testing)- the highest I have seen. Requires some 15 to 20L of IVF (not to mention all the lytes and insulin) before she is ready... Opioids in exchange for (critical) care
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Source Type: forums