Nurse Victorino Chua has been found guilty of murdering and poisoning patients in the hospital where he worked.
The Filipino father-of-two injected insulin into saline solutions before returning them to storage leaving unsuspecting colleagues to administer the poison.
In other cases he falsified patients' charts to increase the dosage of prescribed drugs.
In the Summer of 2011, two years after Chua arrived at Stepping Hill hospital in Stockport, patients suddenly started to suffer unexpected attacks caused by low blood sugar levels.
Two patients - Tracy Arden, 44, and Alfred Weaver, 83, died as a result.
In a letter found by police following his arrest Chua had written what he described as "a bitter nurse confession."
In the 13-page document discovered in a kitchen drawer at home the 49-year-old warned that there was "a devil" in him.
In broken English he said: "I'm writing this letter in case something happen to me my family can continue my case or can tell somebody to look at it and work out how an angel turn to an evil person."
The document was part of an attempt by Chua to manage the anger and frustration that had prompted him to visit an occupational health counsellor at work.
The condition of one of his victims, patient Linda McDonagh, deteriorated rapidly after she was admitted to Stepping Hill.
Her daughter Amanda Thorley still struggles to comprehend the indiscriminate nature of Chua's crimes.
She said: "It's a difficult thing for me personally to try and understand why someone would do that because it is something unthinkable...It shouldn't happen in a hospital.
"The fact that it happened to our mum is extremely distressing and heartbreaking. Because it's so apparently random as well...why her?"
Manchester Crown Court found Chua guilty of two murders and dozens of poisonings or attempted poisonings.
Detective Superintendent Simon Barraclough, who led the police investigation, said that Victorino Chua had "the responsibility of looking after some of the most vulnerable people in our society."
He added: "These are people who were desperately ill and admitted to hospital. Most of the victims are in their 70s and 80s. Some of them had come to hospital to die."
It emerged during Chua's trial that he was taking a combination of anti-depressants, sleeping pills and pain killers.
In the letter found by police he wrote: "Inside of me I can feel the anger that any time it will explode. Just still hanging on can still control it but if I will be pushed they gonna be sorry."
Det Supt Barraclough said the nurse had a big but fragile ego.
He told Sky News: "He's certainly not mentally ill. Whenever he's challenged, whether it be by the hospital, patients or relatives looking after those patients, or whether it be by fellow members of staff, that's what sends him into a rage.
"I think there is an element of arrogance there. I think there's an element of control. He really, really did not like being challenged."
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