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.

Next: Coming to grips with diabetes