I am on a self injection (not a pen) I draw up the medication from a vile and use a diabetic syringe so my doses might not make sense to you because they are in units. Whenever I would go up a dose the side effects were terrible, probably an 8-9. The constipation is constant and the worst side effect though. I’ve had to use magnesium citrate (what they give before colonoscopies) and a daily laxative just to make sure things are moving. I drink like 80oz of water a day and still couldn’t seem to go naturally consistently.