Ans. is 'd' i.e., Acarbose Nateglinide, Glimepiride * Glimepiride and Nateglinide are an insulin secretagogue and it is a well-known fact that insulin secretagogues are associated with hypoglycemia.All the insulin secretagogues 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 be monitored closely in the hospital.Thiazolidinediones (Pioglitazone)Thiazolidinediones are considered "euglycemic" and are efficacious in about 70% new users.Combination therapy of thiazolidinediones with sulfonylureas or insulin can lead to hypoglycemia and may require dose 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 hypoglucemia in the fasting or postprandial states.Acarbose only produces hypoglycemia when used along with other oral hypoglycemics.