Nurse Victorino Chua has been jailed for life with a minimum of 35 years for the murder and poisoning of patients.
Sentencing him, Mr Justice Openshaw called his crimes "despicable and odious".
The judge said: "He has committed a dreadful crime and he must now pay the price."
Relatives of his victims packed the public gallery to see him sent down.
Sky North of England correspondent Nick Martin, at Manchester Crown Court, said Chua stared straight ahead and gave no reaction as he was sentenced.
Filipino father-of-two Chua injected insulin into saline solutions before returning them to storage leaving unsuspecting colleagues to administer the poison.
In other cases, Chua falsified patients' charts to increase the dosage of prescribed drugs.
The 49-year-old was convicted of murdering two patients and dozens of poisonings and attempted poisonings at Manchester Crown Court on Monday after a three-month trial.
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 - suffered agonising deaths as the insulin overdoses starved their brains of oxygen.
A third victim, Grant Misell, 41, survived, but has been told he might never recover from the serious brain damage he suffered at the nurse's hands.
Chua was cleared of murdering Arnold Lancaster, 71, but found guilty of attempting to cause him grievous bodily harm.
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