<prompt> Which does not cause hypoglycemia aEURInsulinGlimipirideNateglinideAcarbose  <response>: Acarhose Nateglinide, Glimipiride Glimipiride and Nateglinide are an insulin secretagogue and it is a well known fact that insulin secretagogues are associated with hypoglycemia. All the insulin secretagogus increase insulin secretion from the pancreas through the same mechanism i.e., by interfering with potassium channel. All the insulin secretagogues have the potential to cause profound and persistent hypoglycemia especially in elderly individuals. Hypoglycemia is usually related to delayed meals, increased physical activity, alcohol intake or renal insufficiency. Individuals who ingest an overdose of some agents develop prolong and serious hypoglycemia and should he monitored closely in the hospital. Thiazolidinediones Pioglitazone Thiazolidinediones are considered eguglycemics and are efficacious in about 70 new users. Combination therapy of thiazolidinediones with sulfonyureas or insulin can lead to hypoglycemia and may require close adjustment. Biguanides Metformin Phenformin Biguanides lower glucose among patients with type 2 diabetes mellitus largely by decreasing hepatic glucose output. It is also thought to increase glucose uptake by skeletal muscles. Because insulin secretion is unaltered hypoglycemia is not a side effect of metfOrmin used as monotherapy. Alpha Glucosidase inhibitors Acarbose Lowers glucose by inhibiting intestinal enzymes that digest carbohydrate there by reducing carbohydrate digestion. Because of its mechanism of action, acarbose, when administered alone does not cause hypoglecemia in the fasting or postprandial states. Acarbose only produces hypoglycemia when used along with other oral hypoglycemics. 