Dear Dr. Roach: I have peripheral neuropathy symptoms in my feet. I am borderline diabetic and keep it under control by eating right. Also, my legs are weak, and I am doing exercises. I was taking the drug Reglan for a couple of months. During the time I was taking it was when I started to have these leg problems. Could this be a side effect of the Reglan? — G.D.

Dr. Roach: Diabetic neuropathy is a complication of longstanding diabetes, especially if it has been poorly controlled. Occasionally, it can show up seemingly early in the course of Type 2 diabetes, but this is thought to represent a delay in diagnosis in otherwise asymptomatic disease or in those who have ignored symptoms. The symptoms of diabetic neuropathy usually begin with numbness, and later on pain and tingling of the feet. Weakness, when it happens, generally comes later on. Metoclopramide (Reglan) is used for nausea and vomiting, especially after chemotherapy, and is used to stimulate the stomach emptying in people with diabetic gastroparesis, which is a type of neuropathy of the nerves to the stomach and intestines. Many or most diabetics with gastroparesis also have diabetic neuropathy. However, metoclopramide should not be given for more than eight weeks due to the risk of tardive dyskinesia, a serious disease of motor control, especially in the facial muscles. Although tardive dyskinesia can cause symptoms in the limbs, weakness would be unusual, and tardive dyskinesia would be very unusual if you took the Reglan only for two months and have stopped. I think it is unlikely that either diabetic neuropathy or the Reglan are causing the muscle weakness. There are many kinds of neuropathies, and all (or nearly all) are more common in people with diabetes. I would revisit your doctor to try to find out more about why you are having leg weakness.


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