Dancing through diabetes.

A New York City Ballet soloist describes her successful fight to keep diabetes from destroying her artistry and her career.

I became an apprentice at New York City Ballet in the fall of 1983, shortly after the death of George Balanchine. By the following year I was a member of the corps de ballet. To my incredible surprise, ballet master in chief Peter Martins gave me the role of the Sugar Plum Fairy in The Nutcracker in only my second year with the company. The following year I was featured in his new ballet, Les Petit Riens. These roles came in addition to many wonderful corps and demisoloist roles that I was regularly performing during our fourteen-week winter season. It was an extremely exciting time for me, and yet a very hard one. Strange things had begun to happen to my body.

First, there were sores that would not heal under my arms, where the costumes rubbed. As the premiere of Riens approached, my body was feeling more and more foreign to me. I was often dizzy, and I was finding it hard to feel my extremities, particularly my toes, when I danced. I could sense Peter's growing frustration with me as I kept falling off pointe for no apparent reason. Increasingly frustrated, I was angry at my body for falling apart at this most important point in my career. In addition to the sores, I was losing weight, feeling thirsty and hungry all the time, feeling spaced out, and urinating frequently. It didn't occur to me that anything was really wrong. Rather, I thought I was extremely tired, maybe from pushing too hard. Then, in the midst of a six-hour rehearsal day, with a performance that evening, I was called to my doctor's office.

I had juvenile diabetes, a disease that would radically change my daily life and the course of my dancing career. At first I wanted to deny what I had been told. I thought that there must be some mistake; the lab had made an error; this condition was just a passing phase. My doctor was giving me pamphlet after pamphlet about diabetes and its terrifying complications. I knew nothing about diabetes or what it would mean to me. All I could think about was that I had to get back to the theater and prepare for that evening's performance.

When I returned I didn't tell anybody what I'd found out. I was panicked about the disease's effect on my dancing. I knew how important it was to look strong and consistent if I wanted to keep getting lead roles. Peter had already told me that the main thing I must do was strengthen my technique. So I feared looking weak. I needed to hide what was happening to me.

There are two types of diabetes, I learned from those pamphlets: juvenile and adult-onset. They are actually very different diseases. The type I have, juvenile diabetes, or Type I, accounts for only 5 to 10 percent of diabetics. It is believed to be an autoimmune reaction in which the beta cells of the pancreas are destroyed, leaving the body unable to make insulin, a hormone. Insulin's job is to open these cells much as a key opens a door. This way the cell can receive its nourishment from the food that we eat, and the cell can work properly. Without insulin, the food, now in the form of sugar, or glucose, remains in the bloodstream (hence the term, "high blood sugar"), and the entire body suffers.

Adult-onset, or Type II, diabetes also leads to high blood sugar, but not because such diabetics lack insulin. In fact, they have plenty of it. However, what they do have is not being properly utilized. Both types of diabetics must concentrate on getting blood-sugar levels down and getting nourishment to the cells. You see, people don't die from diabetes; they die from complications that develop after years of high blood sugar. Diabetes is the leading cause of blindness and kidney failure; it can cause nerve damage that requires amputation, and it greatly raises the risk of heart disease and stroke.

Eventually I did tell the company, but I have never let them see what I've had to go through to stay in performing shape. Educating myself about the disease and how to live and dance with it became my obsession. I needed to learn about insulin injections, monitoring blood-sugar levels, and exploring different diets. Since diet has such a profound effect on insulin levels, I experimented with many different ones to find how each affected my insulin dose. I tried macrobiotics, an ayurvedic diet, Chinese herbs, and vitamin therapies, along with diets involving high protein, high fat, juices, and raw food, among others. And while I have never adhered to any one diet for very long, I have learned much from each. My main problem has not been finding the discipline to follow my new regimen; it's been finding the best regimen to follow--a search that continues to this day.

The hardest thing for me about taking insulin shots has not been the needles or the occasional pain but the inconsistency of my reactions to the shots. Exercise increases insulin sensitivity, which is good, but because I exercise a great deal, I am at constant risk of my insulin overworking and throwing me into an attack of low-blood sugar--a very risky condition. You are in danger of passing out or going into insulin shock or suffering brain damage.

Low blood sugar has been a major problem for me, particularly in the first years of my illness. Because my doctors and I were unaware of how insulin can affect a ballerina's life, my prescribed dose was often excessive. Another problem of particular concern to a dancer with diabetes: infected toes brought on by decreased circulation.

Fortunately, advances in treatment have allowed me to continue performing. A particularly valuable one was the home blood/glucose monitor, which gives the exact blood-sugar level within seconds from a drop of blood drawn by pricking a finger. I carry my monitor with me at all times, and I check myself ten to twenty times a day--first thing in the morning and before classes, rehearsals, performances, and going to bed. Another advance was a recently developed type of insulin that begins working within fifteen minutes. (I used to have to wait from two to six hours for my old, "fast-acting" insulin to kick in.)

Needless to say, I have had many harrowing experiences as a performer on insulin. One of the first occurred when City Ballet was on tour in Copenhagen and appearing at Tivoli, the famous amusement park. I was performing two ballets that evening, a lead in Balanchine's Divertimento No. 15 and a corps part in Robbins's Glass Pieces. Divertimento, the first on the program, did not go as well as I would have liked. My head was spacey and my legs were shaky. I thought it was nerves. But when I checked my blood sugars, I learned that they were too high. My performance had suffered as a result. I was frustrated and angry at my body for having this problem. Into the bathroom with my needle and insulin I went. (Today I know it would be unwise to take a shot in the middle of a performance.) The stage manager called, "Ten minutes," for Glass Pieces, I went down two flights of stairs to stage level to put on my costume. At the five-minute call, terror surged through my body. I began to shake. It felt like I would lose my mind at any moment. I knew that I had to act fast before I went into insulin shock.

I ran back up the stairs and pulled my monitor out of my bag. My hand shook so hard I could barely get the drop of blood I needed onto my strip and into the monitor for my reading. In the middle of an amusement park, listening to the blissful screams of people on a roller coaster outside, I realized that I was on a roller coaster of my own.

The reading that my monitor eventually presented me was shocking! I didn't know I could still be conscious with blood sugar so low. I immediately ate enough sugar tablets to bring it back up, but did not know how long it might be until I felt okay. At that moment I heard the call "Onstage."

I ran down the stairs to stage level. My younger sister, Romy, who was also in the company, was standing in the wings waiting to perform. She took one look at me and began to panic. "What's happening to you?" she asked. I couldn't speak very well, but I was able to tell her enough. Romy pulled me into the changing area and demanded that I take off my costume so she could go on for me. I could barely think straight, but I removed my costume and watched as she put it on. "Okay," she said, trembling, "now tell me what do I do?"

For a moment we just stared at each other. All my counts and steps, who to watch out for and who to get next to for the whole ballet--how could I tell her all this in less than sixty seconds? And Romy was dancing herself--she would have done anything for me in that moment--but I knew it was hopeless. Although Romy continued to fight for my costume, I put it back on.

The sugar would work eventually, I told myself. There was no actual dancing for me in the first two sections, but the counts involved in Glass Pieces made me just as nervous as if I were dancing a lead role. Frankly, I don't remember much about the first movement. What I remember most is the second. I was the leader of the line of women who emerge from the wings in silhouette upstage. The whole audience is focused on us. I didn't know if I would remember my counts. But, even more, I feared passing out. To prevent that I decided to repeat over and over to myself, "My name is Zippora, and I'm going to be all right. My name is Zippora, and I'm going to be all right."

Somehow--probably because of all those rehearsals with Jerry Robbins--my body remembered what to do. By the third movement, when I had to dance complicated steps all out, the sugar had gotten into my system and I no longer feared I would lose consciousness. Of course, my body was totally shaken and I was very disoriented.

That was the first of many different episodes that I would encounter as a performer with diabetes. Many times I questioned whether I could continue to dance, but my love and passion for dancing gave me the strength to continue. I must add how important and helpful it has been for me through the years to talk with those closest to me about what I was going through. I couldn't have made it without their incredible love and support. It has taken me many years to better understand not only how to deal with diabetes but also how to dance with it. I will never be glad that I have diabetes, but I cannot regret what it has taught me. I have been so fortunate to dance with this great company, to perform these great ballets.

Zippora Karz grew up in Southern California and studied dance at the Rozann-Zimmerman Ballet Center in Chatsworth before attending the School of American Ballet in 1980. She was promoted to soloist in New York City Ballet in 1993.