Monosaccharides undergo incorporation into oligo- and polysaccharides. Individual monosaccharides can also undergo a variety of transformations. One important modification of monosaccharides is the formation of deoxy sugars. The most biologically significant of the deoxy sugars is β-D-2-deoxyribose ,in which the C-2 hydroxyl group of ribose has been replaced with hydrogen. This deoxy sugar is the sugar component of DNA.

In the amino sugars, an amino group replaces one or more of the hydroxyl groups. The most common of these sugars are D-glucosamine and D-galactosamine, both of which have an amino group in place of the hydroxyl group on the second carbon. Often, these amino groups are acetylated to give N-acetyl sugars, such as N-acetylglucosamine and N-acetylgalactosamine. These sugars are important components of larger polysaccharides. Other important amino sugars are muramic acid and N-acetylneuraminic acid, which are components of the oligosaccharides of glycoproteins and glycolipids, and of bacterial cell walls. Muramic acid and N-acetylneuraminic acid are glucosamines, which have been linked at either C-3 or C-1 to three-carbon acids. Muramic acid is formed via an ether linkage between the C-3 of glucosamine and the hydroxyl group of lactic acid. N-acetyl-D-neuraminic acid results from the formation of a C–C bond between the C-1 of N-acetyl-D-mannosamine and the C-3 of phosphoenolpyruvate. This and other derivatives of neuraminic acid are collectively called sialic acids and are widely found in bacteria and animals.

Finally, monosaccharides often form ester linkages with phosphate and sulfate ions. In fact it is rare to find free monosaccharide in cells. Glucose is the only unmodified monosaccharide that exists in substantial quantities in living things, in which it exists primarily extracellularly.