Hello, Januvia by itself usually does not cause hypoglycemia. Low blood sugar may occur if it is taken with other anti-diabetic medications such as glyburide. Pioglitazone works by increasing the body s sensitivity to insulin. When used alone it does not cause hypoglycemia which may occur when taken with other diabetes medications, like glyburide. So check your blood sugar regularly as directed and share the results with your doctor. Tell your doctor right away if you have symptoms of hypoglycemia. Symptoms of hypoglycemia include such as dizziness, hunger, or sweating, increased heartbeats, palpitations, etcetera. If you develop these symptoms, your doctor will adjust the dose of the prescribed medication. Hope I have answered your query. Let me know if I can assist you further. Regard, Dr. Mohammed Taher Ali