Ballerina Zippora Karz's Dance With Diabetes
Learning to balance world-class ballet and blood glucose
Repetiteur for the George Balanchine Trust; ballet coach and teacher; diabetes advocate; public speaker; author
The Sugar Plum Fairy in
The Nutcracker, and any
Balanchine Stravinsky ballet
The Sugarless Plum: A Ballerina's Triumph Over Diabetes
In 1987, Zippora Karz was living every little girl's pink tutu-and-toe-shoe dream, performing as a member of George Balanchine's New York City Ballet and dancing iconic roles like The Nutcracker's Sugar Plum Fairy to fawning reviews. But the 21-year-old ballerina had a secret: Although she'd been able to plié her way through symptoms like extreme exhaustion and thirst, on the eve of her biggest premiere to date, persistent sores under both arms threatened her performance—and finally forced her to seek medical help.
Karz got a quick diagnosis: type 2 diabetes. Unfortunately, it was the wrong one. After nearly two years of unrelenting symptoms, wildly fluctuating blood glucose, flip-flopping medical opinions, and one failed treatment after another—all while continuing to perform in the highest echelon of the ballet world—the dancer learned that she actually had type 1. But it took a good while longer before she truly believed it. Eventually, Karz got her health back on track. She went on to become a soloist with the City Ballet, dancing for a total of 16 years before her retirement in 1999.
Today, the ballerina is a teacher and repetiteur for the George Balanchine Trust, traveling across the globe to stage the famed choreographer's works. Now 44 and back in her native Los Angeles, she also works as a motivational speaker who talks about living with diabetes and has recently published a memoir, The Sugarless Plum: A Ballerina's Triumph Over Diabetes. She spoke to Diabetes Forecast about the long road to a proper diagnosis, her scariest live performance experience, and finally learning to balance ballet and blood glucose.
In your book you talk about how your symptoms went on for a while before you finally sought medical advice. What was happening, and why did you let it go on for so long?
To be honest, I don't remember how long it was, because I didn't think my symptoms were really anything to worry about. The extreme thirst, going to the bathroom all the time, being hungry all the time and spaced out in my head—I just attributed it all to exhaustion, because I was dancing 12 hours a day and then performing every night. I was extremely nervous because I had a big premiere coming up—I was new in the company, but they were giving me leading roles and I was under a lot of pressure—and I thought [my symptoms] were a repercussion of that.
Then I developed sores under my arms. Because I was performing in a different piece every night, I was always putting on costumes made for other people and oftentimes the bodice would scrape under my arms. It always happened, but now I had boils under my arms that wouldn't go away and got infected. I got some antibiotics, but the next week, I had like 10 times the amount on both arms. I had this big premiere coming up, and I could barely lift my arms over my head. So I went to the doctor because I was freaked out about my performance, not because I was worried about my health.
What, exactly, did you think of when you heard the word "diabetes"?
My immediate reaction was "this is not me, this is not my life; it was a lab error and once I get some rest, my numbers will go back to normal and all will be fine." I energetically pushed it all away, left the office, and went back to the theater to perform that night.
When did it reach the point where you could no longer deny that you were sick?
We only had two weeks left of the [ballet] season, so I left early. I went home to my grandmother, who was very into health food, and devised a healthy diet. And then a doctor I went to in Los Angeles put me on oral meds. Nobody ever said, "You have type 2 diabetes," but I started reading a lot, and everything I read said, "You're an adult, you're on oral medication, you have type 2."
Because I was a disciplined dancer, I set out to figure out how I was going to reverse it. I couldn't possibly exercise more—I was already dancing more than 12 hours a day—but I knew I could eat better and manage stress better. I was very determined and very strict about what I was eating, and it actually worked. Now I know that I was actually in the "honeymoon phase" of type 1, and I think I was still putting out a small amount of insulin, and everything seemed OK.
When did the honeymoon end?
After a year and a half, two years, I just couldn't stay stable. No matter what I did, how perfectly I ate, I couldn't keep my blood sugars down. So I went to a different doctor and got a new diagnosis. I was told "you were misdiagnosed; you have type 1," and that's when my world came crashing down. To me, going on insulin signified that I really was diabetic. Before that, I kept thinking, "I'm the poster girl for conquering diabetes, through diet, exercising all day, stress management." I thought I had proved all the doctors wrong. Now I had to admit that no matter how healthy I ate and no matter what I did, I had diabetes and it wasn't going to go away. All of a sudden, I hated my body—it was ruining my life—and my dancing started to change. I thought, "How the hell am I going to juggle insulin when I'm dancing all day long—not one or two hours, but all day and all night?" The whole thing was so daunting; I just didn't know how I was going to do it.
How did it go, at first?
Once I started to perform, I was having so many low blood sugars, because I was so inexperienced and this was 23 years ago, and insulins were not as efficient, effective, or consistent as they are today. I felt like a human yo-yo: up and down, up and down, and meanwhile, I'm trying to hide it all from the director and the rest of the company, because I didn't want them to think that the disease had changed me.
No one told me there was such a thing as a diabetes educator, someone I could talk to, to get help through these moment-to-moment struggles, which is a shame, because I think it would have made a difference for me if I had somebody I could call.
You had so many "just in the nick of time" low blood glucose episodes, where a quick gulp of orange juice saved you, at the last minute. What was your worst experience onstage?
It happened when we were performing on tour in Europe, and I was newly trying to understand how to take insulin. I took a shot in the middle of my first performance [of the night], thinking I was way too high, which today I know was not true. Then I was in the last piece, too, and I took a test and was at 20 [mg/dl] right before my second performance—20! It was a very dramatic moment. They're screaming for me onstage, and I'm throwing handfuls of glucose tablets down my throat, shaking so hard. I went to find my sister [who was also a dancer in the company] in a panic, and she was trying to put my costume on so she could dance the role, but there was no way I could teach her a role I'd been learning for months in seconds, and so I went onstage with the corps de ballet and danced.
I never had an episode quite that bad again, but I was having so many low blood sugars that I decided "this isn't working for me." I should have gone to the doctor and said, "This isn't working. Can we reevaluate my lifestyle with my insulin?" But instead I went to somebody new. My next doctor couldn't believe the severity of my hypos and thought it was far too dangerous to go so low all the time. He also thought I had type 2, and told me to stop the shots and put my meter away, that I was being too obsessive with the diabetes stuff. I felt dumbfounded—how could I have been so misled on such the wrong path? But on the other hand, I still so badly wanted not to have type 1 or to be on insulin, that this was the most beautiful news I could have ever heard, and I gladly accepted it.
As a ballet dancer you were clearly used to discipline and order—how did all of these physical and emotional ups and downs affect you?
What happened to me, with all the highs and lows, is that I went from being somebody very rational, with a practical, clear perspective and lots of discipline, to a person I almost didn't recognize, with no perspective. My mentality was different. I was starting to become very paranoid. I started feeling out of control because I was off insulin and my blood sugars were rising, but I was refusing to check because I didn't want to become "obsessive" or to be a person with diabetes ever again. I became as rigid about never checking myself as I had been about checking myself.
Also, I had always been very health conscious and disciplined about my diet, but I was hungry all the time and became out of control. I started eating candy bars, doing things I never would have done before. At the same time, I started to lose a tremendous amount of weight, too, because my sugars were soaring through the roof. People started talking about me like I was anorexic, and I just thought, "No one understands, I'm just doing what I'm supposed to do," and meanwhile I'm not checking sugars or doing anything to help myself.
It's so hard for me to look back on that time. It sounds like I was just crazy, but all I can say is that I know how much love and meaning dancing gave me—it was my life, all that mattered in life. At that time, I was like a person dying of thirst, and every time I got to dance onstage it was like I got a drop of water—those were the moments I was living for—and I simply wasn't willing to ever go back to something that would jeopardize that, and to me taking shots of insulin was jeopardizing my dancing.
Did you ever consider quitting?
[Once I was properly diagnosed] things got easier; I learned key things, like don't take a shot during a performance—if my blood sugar was a little high, that's OK, because it's more important not to have hypos onstage. I also had to deal with the perfectionist part of me that wanted to be a perfect ballerina. I had to let go of that and accept that my performance wasn't always going to be perfect. As a ballerina, it's so important to feel intricately connected to your body, and I lost that when my sugars were off. So I had to let go of trying to maintain that level of perfectionism, and to accept it's more important that I be OK, that something not happen to me onstage. So if I was off, I was off. And it was at that time, ironically, when I started to think "maybe this is not a suitable lifestyle for someone with type 1 diabetes. Maybe I should be grateful that I had a good run in the world of George Balanchine and Jerome Robbins and Peter Martins and leave." I almost quit many, many times; it was a very difficult thing for me. But I didn't, because I realized that if I quit, then I was using diabetes as an excuse.
But it was hard. I was tired of feeling bad about myself and not living up to my potential. I was around the most athletic bodies in the world, dealing with a disease. That was harder for me than the diabetes. But I stayed and didn't use diabetes as an excuse, and really gave my insulin regimen a chance. Years later, I was promoted to a soloist ballerina in the company—in 1993, six years after my diagnosis. I danced for 16 years overall and had a wonderful career with the New York City Ballet, had great experiences onstage, and proved to myself that I could maintain that level as a person with type 1 diabetes. I wasn't always perfect and I didn't always feel like I achieved my full potential, but when I look back now, having had to work on my compassion and let go of my intense perfectionism, I can say that what I did was good enough.
How do you feel today?
Healthier than I probably ever have before. My lifestyle is very different; I'm not exercising 12 hours a day, so it's much easier for me, physically. I also don't have the anxiety I used to. I feel very balanced in the way I've learned to live my life. Because of that, my blood sugars are very stable now—I don't have all the highs and lows. Currently, I use the FlexPens, with long-acting and short-acting insulins. I wouldn't be opposed to a pump, but the pens have worked for me, and I'm very happy with my blood sugar control. Now I'm grateful to insulin. I used to hate it and think it was an evil thing, but now I see insulin as life-giving.
Can you talk specifically about your foot issues, as a diabetic ballerina?
Well, I used to get blisters and corns a lot, and they would get infected. In the beginning, because I was terrified that anybody would think it was diabetes-related, I would dance on my infections, often to the point of real danger. That was another issue that took me years to come to terms with—knowing that when an infection started, I should just stay off the foot. I mean, when I danced on an infection I would end up missing many more performances than if I just took off one show to heal.
I had to be very meticulous with my feet because I was on pointe all day. So I learned to always change my socks during the day. A lot of dancers "wore" bare feet, but I always wore white cotton socks and kept my toes very dry with different powders. Trying to find the right fit for shoes was also important. I was always changing my specifications, in hopes that I wouldn't get corns if I just found the right fit. But I never found it in 16 years! To my last month of performing, I was still wondering if this should be a little wider right there. I was always changing my shoes, and had different specifications for each foot. It took years, but I learned how to do it all.
Tell me why it's so important for you to be involved in advocacy work.
What brings me meaning in my life now is connecting to people. I feel it's important for those of us who have been able to do things in life despite our obstacles to share that, especially with children and teens. Everybody's going to have some obstacle—if not with the body, it might be something else—and I think it's very important to share the spirit of how not to give up and how to persevere and how to really find a passion in your life. So I share my story with people, and also try to get them moving—I love getting people up and moving to music, sharing the joy I have of moving with people.
It's interesting how balance has played such an important role in your life.
Yes, the irony is not lost on me—there I was trying to balance perfectly on my toes, while trying to balance my blood sugars and my own psychology—trying to balance my life, in general. That was part of my constant struggle. I wanted to prove to myself that I wasn't just going to have one good performance; I wanted to prove to myself that I could maintain consistency, that I could balance being both a ballerina and a diabetic. And I did find that in the end. Now I'm very balanced. I don't have the highs I used to have as a performer—I don't think anything will bring me that sense of magic I had on stage—but I have a sense of peace.