@lhankins my doctor, director of endocrinology at a major teaching hospital, now suggests the ramping up method in his practice, just to reassure you. He also said even if I could get to a half dose, it would be helpful.

Effectiveness does increase with dose, even for us small people. I never got to the full 8 (80mcg) clicks but did get to 7 and had excellent gains. My doctor was happy with 6 clicks.

I didn't ask permission to do this but my doctor was delighted that I could get on the med. You will need extra needles and if you are not doing a full dose, you need to keep the medication in the refrigerator so it lasts past 30 days- doctor, company and pharmacist all approved this.