Eicosanoids derived from n-6 and n-3 polyunsaturated fatty acids (PUFAs), serving as important signaling molecules, are implicated in many physiological and pathological processes, including Type 2 diabetes mellitus (T2DM). However, the quantification of endogenous eicosanoids is challenged by high structural similarity, low abundance in biological sample and poor electrospray ionization efficiency. In the current study, a sensitive and accurate liquid chromatography-tandem mass spectrometry (LC-MS/MS) method was developed to quantify 65 eicosanoids derived from n-6 and n-3 PUFAs in plasma samples using twin derivatization strategy with a pair of reagents, 5-(dimethylamino) naphthalene-1-sulfonyl piperazine (Dns-PP) and (diethylamino) naphthalene-1-sulfonyl piperazine (Dens-PP). Dns-PP-derivatized plasma sample was mixed with the equal volume of Dens-PP-derivatized eicosanoid internal standards for LC-MS/MS analysis in multiple reaction monitoring (MRM) mode. After Dns-PP derivatization, the ionization efficiency and separation performance were substantially improved, resulting in the enhanced sensitivity by 446- to 1009-folds compared to intact eicosanoids. The quantitative accuracy determined by twin derivatization method was found to be comparable with stable isotope labeled internal standards (SIL-IS) method. The newly proposed method was successfully employed to quantify the target eicosanoids in plasma samples from healthy controls and the patients with T2DM. N-6 PUFA-derived eicosanoids, PGF2α, PGD2, PGE2, PGA2, PGB2, 20-HETE and LTC4, significantly increased in plasma sample of T2DM patients. Oppositely, n-3 PUFA-derived eicosanoids, RvE1, 12(S)-HEPE and RvD1, remarkably decreased. Spearman's correlation analysis indicated the strong correlations between these highlighted eicosanoids and clinical parameters of T2DM. Collectively, the sensitive and reliable eicosanoid quantification method may facilitate to elucidate the characteristics of eicosanoid metabolism and understand the role of eicosanoids in the pathogenesis of T2DM and other diseases.