This chapter reviews recent data that support a special function of astrocytes in the detection of hypoglycemic emergencies and initiation of the rapid, life-saving homeostatic adjustments to hypoglycemia together referred to as 'counterregulation'. It focuses on the role of hindbrain astrocytes in counterregulatory response (CRR). Severe glucose deficits caused by acute food deprivation or medication errors can be life-threatening, physiological emergencies. Type 1 diabetes (T1DM) patients display an increase in brain lactate concentrations during hypoglycemia relative to nondiabetic patients. Classically, the astrocyte has been thought to play a subservient role to the neuron in the control of central nervous system (CNS) function. Changes in astrocyte metabolism are observed in response to acute hypoglycemia in individuals with T1DM, as well as in diabetic patients with hypoglycemia-associated autonomic failure (HAAF) under hypoglycemic conditions. Understanding the detailed mechanisms connecting glial metabolism with gliotransmission will be instrumental to formulating therapies to overcome HAAF.