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​​​​​​​​​​​​Real Madrid’s Nacho has been Type 1 diabetic since the age of 12


Even though he was diagnosed with Type 1 diabetes at the age of twelve, Nacho Fernández remains steady in Real Madrid’s defence

Despite being told by doctors as a twelve-year old that he would never make it as a footballer due to being Type 1 diabetic, Nacho Fernández has turned out for Real Madrid in all defensive positions to date.  

Nacho’s been around the club for a long time; and continues to impress with his commitment.  Signed originally as a youth team player in 2001, his progression to the first team was via the cantera. 

And for someone who’s often thought of as a fringe player, Nacho’s now clocked up over a hundred first-team games for Real Madrid; reaching that milestone against Alavés in February, 2018. 

He’s put in a few more appearances since then, though, and Nacho will now be approaching the 200 mark.  Not bad for someone who was once told he’d never play football again due to his condition.

On UEFA’s own website (link below), there is a short interview in which Nacho speaks of his condition and how he was encouraged by another doctor to continue playing as opposed to giving up the game.

Nacho has spoken freely of his diagnosis over the last few years and in truth, it’s not uncommon in football to come across players who are diabetic.  However, like in most other sports, the urge to compete often over-rides everything else! 

Nacho is no exception; and he will have been able to take heart from the many other athletes and footballers who are diabetic. 

This will have helped to help illustrate that, contrary to what his original doctor told him, people who are diabetic can and do participate in sport at the highest level.

In Nacho's case, being diagnosed at such an early age will have helped him learn to manage his condition to the best of his ability.


Once he had established that diabetes was no barrier to success there was no need for him to withdraw from active participation in football or any other sport for that matter.

It certainly helps if diabetes is diagnosed early enough.  That way time is available for a gradual and progressive adjustment to a change in lifestyle together with an acceptance of the condition. 

If the diagnosis is made later in adult life, being told you are diabetic can often be difficult to deal with.

In speaking highly of his endocrinologist, Dr Ramírez, to whom he credits for ensuring he continued playing, Nacho refers to his diet a lot, and explains how he has to be careful about what he eats. 

Although the same underlying principles of sports nutrition are present throughout, athletes need to take extra care due to the high intensity of exercise associated with training and playing competitive sports.

With sportspeople in particular, a lot of work has been done in recent years to address nutritional and exercise modifications.  It’s now accepted that education and understanding of the condition are key factors in the management of diabetes. 

The primary risk of physical activity in patients with uncomplicated diabetes is exercise-induced hypoglycaemia and worsening of hyperglycaemia and / or ketosis when insulin levels become insufficient (Iafusco, 2006). 

Ketosis is the process in which the body starts to break down fat for energy when there's not enough insulin available. 

This happens as blood sugar levels start to drop, often as the result of following a low or minimal carbohydrate diet, and the body begins to use fat as a source of energy.  This leads to a build-up of acid in the blood which is known as ketosis.

So with regards to exercise, people with type 1 diabetes must avoid behaviour that is likely to put them at risk. 

They also need to be given specific recommendations to adjust their diet so they are prepared to counteract or prevent a drop in glucose levels during exercise or sports (Hornsby and Chetlin, 2005).

It’s not only that, though, special consideration is needed with regards to travel, medication and recovery from injury (Jimenez, 2007); so from the club management aspect there’s a lot to think about.

Individually, however, developing a strong subject knowledge of diabetes together with a thorough understanding of its effects is essential when participating in sport and exercise at any level.

This in turn leads to that sense of ‘forewarned is forearmed’ which can be reassuring.

Nacho will have become a ‘bit of an expert’ himself with regards to diabetes.  Over the years he'll have got to know as much as possible about his condition and will have taken every opportunity to learn more about it whenever possible. 

This will have included interacting in both formal and informal ways with other diabetics including diabetic athletes, and gleaning as much information from them as possible; thus adding to his own subject knowledge. 

So as far as the daily management of the condition is concerned, the key to success lies in knowing your condition; and there’s no doubt Nacho is well on top of that.

From a footballing aspect, the fact that Nacho is diabetic wouldn’t have influenced Real Madrid coach Zinedine Zidane’s decision-making one bit; either this time around or during the French coach's previous spell managing Madrid. 

The same applies to the other two coaches sandwiched between Zidane’s two periods in charge at the Bernabéu.  Like Zidane, both Julen Lopetegui and Santiago Solari will have known about Nacho’s condition for years. 

Despite being diabetic, Nacho won't be treated any differently to anyone else in Real Madrid's squad.  He'll be no exception to Zinedine Zidane’s selection policies; and the same applies to his international involvement with Spain. 

National team coach Robert Moreno, who took over after Luis Enrique resigned due to personal matters, isn't going to do Nacho any favours either just because he's diabetic. 

In recent seasons at Real Madrid, the choice of central defensive partner for skipper Sergio Ramos has been dictated largely by injury.  French stopper Raphaël Varane appeared to be the preferred option with Nacho in the supporting position for both players. 

However, Nacho’s versatility helps and he was able to comfortably slot-in to cover Dani Carvajal at full back both for Real Madrid and for the Spanish national team.

Although there’s no guarantee that Nacho willl keep his place in either team any more than the others will, he's certainly a  valuable player based on his reliability alone.

But steady dependable squad members who can play in a variety of positions rarely get the accolades they deserve from the press and public; even though their contribution is recognised by the coaches and managers.​


As the complete professional, I’m sure Nacho will be happy with the latter.


References:

Hornsby WG Jnr, Chetlin RD (2005).  Management of competitive athletes with diabetes.  Diabetes Spectrum.  Vol. 18; 102 – 107.

Iafusco D (2006). Diet and physical activity in patients with type 1 diabetes.  Acta Biomed.  Vol. 77; Supplement 1.  41 – 46.

Jimenez CC (2007).  Diabetes and exercise: the role of the Athletic Trainer.  Journal of Athletic Training.  Vol. 32 (4); 339 – 343. 

Madrid’s Nacho on Diabetes:  "I was told my footballing days were over".  Available from: http://www.uefa.com/uefachampionsleague/news

Accessed March 13th, 2017.


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