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everal years ago I wrote a book titled The Girl Who Fell Down. It was about Joan McCracken, a Broadway dancer and actor of the 1940s and 1950s who was married to Bob Fosse. While the book's title refers to McCracken's famous role as the Girl Who Falls Down in the original cast of Oklahoma!, I also used the phrase metaphorically to represent the tragic downturn of McCracken's life. A diabetic, she faced the virtually impossible task of maintaining a performing career. She developed numerous health problems, fought to keep her diabetes a secret for fear of not getting hired because of it, and died of a heart attack at age 43.

The good news is that was almost half a century ago. Today, with all the advances in knowledge, technology, and treatment of the disease, it is possible for performers with diabetes to enjoy successful show-business careers—but only if they are careful about monitoring their symptoms and conscientious about following doctors' instructions.

Last summer, Luke Longacre was cast in the Broadway musical The Times They Are A-Changin'. Despite having been diagnosed with Type 1 diabetes at the age of 8, Longacre had enjoyed a successful career as a professional dancer, appearing in regional theatre productions and in Lincoln Center Theater's The Frogs. But the rehearsals for Twyla Tharp's choreography in The Times They Are A-Changin' required him to dance barefoot. "I developed blisters on my feet, and they got infected," Longacre says. "I wound up in the hospital and was told they would have to amputate my toes. Because of my diabetes, which weakens the body's immune system, the infection had spread into my bones, and they were afraid it was going to shoot right up my leg. Before amputating, they decided to try one last drug. It was a crazy-strong antibiotic that I had to take for six weeks by I.V. in my arm. Fortunately, it worked."

Despite his close call with the Tharp show (which he never got to perform in), Longacre has managed to continue building his dance career by following a very strict process. "In every show I do," he says, "it starts off with my talking to the stage managers about their keeping a pack of snacks for me with their kit. During rehearsals, it must be known that I'm allowed to go back and forth to my pack of snacks whenever I need to. During the run of the show, all my dressers have glucose tablets, which are really easy and quick to digest and don't make you feel full like eating food would. I have those tablets strategically placed around the stage and in the wings."

The crux of the problem for diabetics is maintaining the proper balance of blood sugar (glucose) and insulin. Type 1 diabetics do not produce any insulin (Type 2s usually produce some) and must inject themselves with the substance regularly, making certain to calculate the amount and timing of their injections based on how much glucose is in their bloodstream. The glucose level can be determined roughly by considering the kinds and amounts of food one is eating, or more accurately by using a glucometer, a small electronic device that displays a numerical blood-sugar reading when a tiny drop of blood is placed on it. This reading is used to determine the appropriate amount of insulin to inject. If too much insulin is injected, the diabetic will suffer from low blood sugar and might pass out. This is when he or she may need to quickly take a glucose tablet or sugar snack. If too little insulin is injected, over time the diabetic will suffer a host of health problems that can affect many different parts of the body.

For a dancer, the problem is exacerbated because exercise has an insulinlike effect on the body. Even if the diabetic has injected the proper amount of insulin to balance his or her food intake, excessive exercise can dangerously tip the balance. Because dancing in a show involves the complicated timing of expenditures of energy, diabetic dancers need to be especially meticulous about measuring their glucose level continually. "Sometimes my blood sugar will drop even before the show starts," Longacre explains, "because I've just done a full 30-minute warm-up. I really have to make sure that I eat a good carbohydrate-loaded meal about two hours before the show, so my energy will stay up through the beginning of the performance. Then once the show starts, it's all about maintaining that as the dance numbers go on. What usually happens is that I will overdo it. I'll start to feel a little low, and I'll quickly take 10 glucose tablets, afraid that I won't have enough energy to get through the next few numbers. And then I'll discover that I've taken too many and my blood sugar will go too high. During the performance you don't have time to get out the glucometer and test your blood, so you have to just estimate based on how you feel. You also don't have time to take only one or two tablets and wait and see how they're working."

Longacre has been performing recently in a production of Seven Brides for Seven Brothers in which the director, Scott Schwartz (son of composer-lyricist Stephen Schwartz), and one of the actors, Becky Barta, are also diabetics. Unlike in Joan McCracken's day, when performers felt the need to keep their diabetes a secret so as not to hinder their careers, today performers are much more comfortable about going public with their disease. "The more people who know you have the disease, the better," says Longacre, who credits Barta with introducing him to glucose tablets. "You need to take it upon yourself to initiate conversation and make sure people know how to treat you if you have a problem. Talking about it more, as opposed to less, is what we both advise."

Barta, a Type 1 diabetic since the age of 6, has sustained a 20-year career as an actor-singer in Broadway, Off-Broadway, national touring, and regional theatre productions. "I have experienced both highs and lows [in blood sugar] during performances, but, thankfully, in my career real problems have been very few and far between. I don't think anyone has ever asked for their money back after any performance in which I may have had a problem," she jokes. "I'm very good at keeping glucose tablets within reach offstage. And it's great when I can have a pocket in my costume. For about three years, I performed the role of Mrs. Claus in the Christmas show at Radio City. There's a funny bit where Santa calls me on a cell phone. My costume had a pouch for the phone, and I was always able to keep a piece of sugar tucked in there."

Barta finds that the challenge of managing her diabetes actually gives her a very positive feeling about her relationship to her physicality. "I am acutely aware of the health of my body, not just on a day-to-day basis but on an hour-to-hour basis. I'm probably taking much better care of myself overall than people for whom moment-to-moment health is not an issue."

Barta's primary advice to diabetics is to visit their doctors regularly. "In addition to my endocrinologist, podiatrist, and GP, I also see a retinologist," she says, "because diabetics tend to grow blood vessels in their eyes which can cover up the retina and cause blindness." Barta also urges performers not to be shy or lazy about checking their blood sugar whenever they need to and to remedy the situation as quickly as possible. "And don't feel you can't be a part of everything that's going on in a show. Just be smart about it. If it's someone's birthday and they're having a cake for them backstage, then by all means join everyone and have a piece of cake—just remember not to have that extra roll at dinner."

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