Derangement in glucose metabolism can be caused by glucocorticoids through decreased insulin production, increased insulin resistance, and altered glucose synthesis. Steroid-induced diabetes should be managed similarly to glucose control used for other patients in the ICU. Insulin infusion therapy to control hyperglycemia is often necessary. Hyperglycemia secondary to glucocorticoid treatment typically recedes within 48 hours of discontinuation of the glucocorticoids.

The immune-modulating effects of glucocorticoids are central to their therapeutic effects as well as one of their greatest limitations. They can cause a leukocytosis in the absence of systemic infection. Immune suppression occurs from effects on inhibition of inflammatory cells as well as inhibition of the release of cytokines and proinflammatory modulators. Some have suggested that systemic fungal infection is a contraindication to the institution of steroid therapy.