Large scale herbivorous insect outbreaks can cause death of regional forests, and the events are expected to be exacerbated with climate change. Mortality of forest and woodland plants would cause a series of serious consequences, such as decrease in vegetation production, shifts in ecosystem structure and function, and transformation of forest function from a net carbon sink into a net carbon source. There is thus a need to better understand the impact of insects on trees. Defoliation by insect pests mainly reduces photosynthesis (source decrease) and increases carbon consumption (sink increase), and hence causes reduction of nonstructural carbohydrate (NSC). When the reduction in NSC reaches to a certain level, trees would die of carbon starvation. External environment and internal compensatory mechanisms can also positively or negatively influence the process of tree death. At present, the research of carbon starvation is a hotspot because the increase of tree mortality globally with climate change, and carbon starvation is considered as one of the dominating physiological mechanisms for explaining tree death. In this study, we reviewed the definition of carbon starvation, and the relationships between the reduction of NSC induced by defoliation and the growth and death of trees, and the relationships among insect outbreaks, leaf loss and climate change. We also presented the potential directions of future studies on insect-caused defoliation and tree mortality.